Physical activity and play behaviours in children and young people with intellectual disabilities: A cross-sectional observational study

The benefits of physical activity and active play for children and young people are well established. However, there is a lack of physical activity research involving children and young people with intellectual disabilities. This study investigated habitual physical activity and recess play behaviour in 70 5- to 15-year-old participants with intellectual disabilities using objective methods (accelerometers) and systematic observation techniques. Results showed that few children were active enough to benefit their physical health (23% of the cohort). No differences in habitual physical activity, sedentary behaviour, or recess play behaviours were observed between boys and girls. Participants spent most of their recess time alone or playing in small groups, with no participants engaging in large group play. Older participants spent more recess time playing in small groups rather than playing alone and participants with Autistic Spectrum Disorder spent more time engaged in active pursuits and less time standing than non-Autism Spectrum Disorder participants. Positive correlations were observed between time spent alone and physical activity. These findings contrast with those typically observed in a mainstream school setting. In conclusion, interventions designed from formative research are needed to promote physical activity within this population. Implications for school psychologists are discussed

Physical activity patterns in youth with intellectual disabilities

The aim of this study was to assess the physical activity (PA) patterns of youth with intellectual disabilities (ID). PA was monitored for 7 days in 70, 5 – 15 year old participants using accelerometers. Thirty two participants were included in the final analysis. Habitual PA and the number of continuous bouts accrued for a range of bout lengths (5-600 seconds) for light (LPA), moderate (MPA) and vigorous (VPA) intensity PA were calculated. Multivariate analysis of covariance was used to assess differences in the number of continuous bouts by sex, age, ID group and between week and weekend days. Participants exhibited short sporadic bursts of activity. The number of continuous bouts decreased as the intensity and duration increased. Few differences in PA patterns were reported by sex, ID group, age group and between week and weekend days, possibly due to the generally low PA levels within this population

Physical activity, sedentary and playtime behaviours in children and adolescents with intellectual disabilities

Despite the wealth of research examining physical activity (PA) in children and adolescent without disability, there is a lack of research that has focussed on PA related to children and adolescents with intellectual disabilities (ID). The evidence that does exist in this area suggests that children and adolescents with ID are less active than their non-ID peers. The school environment offers numerous opportunities to engage in PA regularly, yet to date, school-based research focussing on PA in children and adolescents with ID is limited. Thus, the primary aim of this thesis was to investigate PA, sedentary time (ST) and playtime behaviours in children and adolescents with ID.Four study chapters are included in the thesis. Study 1 used uniaxial accelerometers to investigate habitual PA levels, sedentary behaviour and PA patterns in children and adolescents with severe and moderate ID. Results demonstrated that participants engaged in low amounts of PA, spent a large proportion of waking hours in ST and mainly engaged in short, sporadic bursts of PA.Study 2 investigated the PA levels of children and adolescents with severe and moderate ID during playtime and PE contexts using direct observation techniques. Participants engaged in similar levels of moderate to vigorous PA (MVPA), and spent minimal amounts of time engaging in sport based activities during playtime and PE. At playtime participants spent the majority of time playing alone or in small groups and no participants engaged in any large group play.Study 3 explored teachers’ perceptions of PA engagement for children and adolescents with ID. Teachers reported that pupils prefer to engage in fun, unstructured activities. Parents and teachers were identified as key role models who can influence PA engagement for this population and teacher participants explained that pupils with ID have limited understanding around PA and the benefits to health.Study 4 evaluated the effectiveness of a school-based PA intervention, delivered in two primary special educational needs (SEN) schools. The intervention demonstrated promising results, with an increase in accelerometer assessed MVPA levels between baseline and follow up of ~18mins. However, these findings were not statistically significant, possibly due to the small sample size involved. Minimum clinically important difference analysis suggested that changes in MVPA were likely to be beneficial to heath. Furthermore, qualitative data generated through teacher interviews highlighted positive intervention effects across the school.Overall the studies presented in this thesis provide an overview of PA engagement and associated behaviours in children and adolescents with ID. The major findings presented suggest that children and adolescents with moderate and severe ID are not sufficiently active, and the SEN school environment may be an important area to target PA interventions. The current thesis has made a significant contribution to our understanding related to the PA in children and adolescents with ID and has highlighted a number of recommendations for future research

Exploring teachers' perceptions on physical activity engagement for children and young people with intellectual disabilities

Aim: To explore teacher’s perceptions of barriers and facilitators to physical activity, including enabling, reinforcing and predisposing factors amongst children and young people (CYP) with intellectual disabilities (ID). Method and procedures: The Youth Physical Activity Promotion (YPAP) model was used to inform semi-structured focus groups to explore physical activity of CYP with ID. Participants were 23 (9 male) teachers and teaching assistants, from 3 special educational needs (SEN) schools (1 = Primary, 2 = Secondary) within North West England. Three focus groups were held with between 6 and 8 participants, audio and video recorded and data transcribed. Data were inductively and deductively analysed using Nvivo and represented through pen profiles. Results: Three pen profiles were developed and structured around YPAP model to display themes within the data. Enabling factors (facilities (n=23) and activity type (n=39)); reinforcing factors (influences of peers (n=23), family (n=10) and teachers (n=19) to physical activity engagement); predisposing factors (healthy lifestyle (n=15), enjoyment of physical activity (n=14), adaptations for physical activity (n=10), structured play (n=10), effects of disability on physical activity (n=8) and the CYPs attitudes towards physical activity (n=8)). Conclusion: CYP with ID enjoy engaging in physical activity, particularly activities that are of a fun and unstructured nature which allow for progression of skills and promote independence. Participants recognised that they, as teachers, had an influence on the CYP’s physical activity engagement, however suggested that parents have the most influential role. Similar to previous research, participants noted that CYP with ID had a lack of understanding as regards the importance of physical activity engagement and its benefits to health. It is suggested a strong home-school link for CYP within SEN schools could prove to be a key facilitator for active and healthy lifestyles education and choices

What does the COVID-19 pandemic mean for the next decade of onchocerciasis control and elimination?

BACKGROUND: Mass drug administration (MDA) of ivermectin for onchocerciasis has been disrupted by the coronavirus disease 2019 (COVID-19) pandemic. Mathematical modelling can help predict how missed/delayed MDA will affect short-term epidemiological trends and elimination prospects by 2030. METHODS: Two onchocerciasis transmission models (EPIONCHO-IBM and ONCHOSIM) are used to simulate microfilarial prevalence trends, elimination probabilities and age profiles of Onchocerca volvulus microfilarial prevalence and intensity for different treatment histories and transmission settings, assuming no interruption, a 1-y (2020) interruption or a 2-y (2020-2021) interruption. Biannual MDA or increased coverage upon MDA resumption are investigated as remedial strategies. RESULTS: Programmes with shorter MDA histories and settings with high pre-intervention endemicity will be the most affected. Biannual MDA is more effective than increasing coverage for mitigating COVID-19's impact on MDA. Programmes that had already switched to biannual MDA should be minimally affected. In high-transmission settings with short treatment history, a 2-y interruption could lead to increased microfilarial load in children (EPIONCHO-IBM) and adults (ONCHOSIM). CONCLUSIONS: Programmes with shorter (annual MDA) treatment histories should be prioritised for remedial biannual MDA. Increases in microfilarial load could have short- and long-term morbidity and mortality repercussions. These results can guide decision-making to mitigate the impact of COVID-19 on onchocerciasis elimination

Motor competence assessments for children with intellectual disabilities and/or autism: a systematic review.

Objective: Gross motor competence is essential for daily life functioning and participation in physical activities. Prevalence of gross motor competence in children with intellectual disabilities (ID) and/or autism is unclear. This systematic review aimed to identify appropriate assessments for children with ID and/or autism. Design & data sources: An electronic literature search was conducted using the EBSCOhost platform searching MEDLINE, Education Research Complete, ERIC, CINAHL Plus and SPORTDiscus databases. Eligibility criteria: Included studies sampled children with ID and/or autism aged between 1 and 18 yrs, used field-based gross motor competence assessments, reported measurement properties, and were published in English. The utility of assessments were appraised for validity, reliability, responsiveness and feasibility. Results: The initial search produced 3182 results, with 291 full text articles screened. 13 articles including 10 assessments of motor competence were included in this systematic review. There was limited reporting across measurement properties, mostly for responsiveness and some aspects of validity. The Bruininks-Oseretsky Test of Motor Proficiency-2 followed by The Test of Gross Motor Development-2 demonstrated the greatest levels of evidence for validity and reliability. Feasibility results were varied, most instruments required little additional equipment (n=8) and were suitable for a school setting, but, additional training (n=7) was needed to score and interpret the results. Conclusion: This review found the BOT-2 followed by the TGMD-2 to be the most psychometrically appropriate motor competency assessments for children with ID and/or autism in field-based settings. Motor competence assessment research is limited for these cohorts and more research is needed

Converting between estimates of moderate-to-vigorous physical activity derived from raw accelerations measured at the wrist and from ActiGraph counts measured at the hip: The Rosetta Stone

The ability to compare published group-level estimates of objectively measured moderate-to-vigorous physical activity (MVPA) across studies continues to increase in difficulty. The objective of this study was to develop conversion equations and demonstrate their utility to compare estimates of MVPA derived from the wrist and hip. Data from three studies of youth (N = 232, 9-12yrs, 50% boys) who concurrently wore a hip-worn ActiGraph and a wrist-worn GENEActiv for 7-days. ActiGraph hip count data were reduced using four established cutpoints: Evenson, Pate, Puyau, and Freedson 3MET. Wrist accelerations were reduced using the Hildebrand MVPA 200 mg threshold. Conversion equations were developed on a randomly selected subsample of 132 youth. Equations were cross-validated and absolute error, absolute percent error, and modified Bland-Altman plots were evaluated for conversion accuracy. Across equations R2adj was 0.51-0.56 with individual-level absolute error in minutes ranging from 7 (wrist-to-hip Puyau) to 14.5 minutes (wrist-to-hip Freedson 3MET) and absolute percent differences ranging from 13.9%-24.5%. Group-level cross-validation to convert hip-to-wrist MVPA resulted in average absolute percent errors ranging from 3.1%-4.9%. Conversion of wrist- to-hip MVPA resulted in average absolute percent errors ranging from 3.0%-10.0%. We recommend the use of these equations to compare published estimates of MVPA between the wear-site cut-point combinations presented

Associations between motor competence and physical activity levels of children with intellectual disabilities and/or autism spectrum disorder: Movement matters

Motor competence is important for lifelong physical activity (PA). The current study aimed to examine associations between PA and motor competence. In total, 43 children aged 7–12 years with intellectual disabilities and/or autism spectrum disorder completed anthropometric measures, the Bruininks-Oseretsky Test of Motor Proficiency-2, and wore a wrist accelerometer to capture total PA, moderate-to-vigorous PA (MVPA), average acceleration, and intensity gradient. No significant associations were found between PA outcomes and motor competence. Motor competence performance was commonly ‘below average’ or ‘average’. The weakest subtests were upper limb coordination and strength. The strongest subtest was running speed and agility. Total weekly MVPA was 336.1 ± 150.3 min, higher than UK recommendations of 120-180 per week for disabled children and young people. Larger scale studies are needed to better understand the relationship between PA and motor competence. Future research should also consider the influence of environmental factors on PA in this group

Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals